"David Cameron is the first PM in history to set out five pledges to protect the NHS from his own policies, yet he has already broken two of them," Mr Miliband said.

"The number of people waiting 18 weeks for treatment has gone up. He has not protected the health service budget.

"He has spent a year mismanaging the NHS. The consequence is chaos, confusion and damage to patient care.

"Hundreds of millions of pounds which should have been used for patient care are being wasted on handing out redundancy notices to staff from PCTs - staff who may now have to be rehired."

Liberal Democrat fears that the NHS reform bill would turn into a 'totemic' issue have proved well-founded, as the coalition delivers a series of increasingly frantic defences of the legislation.

Conservative backbenchers, who are largely supportive of reforms that would create GPs' consortia and allow more involvement from the private sector, have been irritated by comments from Nick Clegg promising that there would be no competition watchdog in the NHS and suggesting the bill would go back to committee stage.